Inspection of the x-ray should be thorough, methodical and complete. The lateral (cross-table) view is the most helpful x-ray study in diagnosing c-spine injuries. Shoulders can be depressed by pulling the arms down slowly and steadily, or if the patient is capable, asking them to depress one shoulder and lift the other hand above his head to achieve the swimmer’s position, which better visualizes the lower vertebrae.įigure 2: Two examples of a cervical x-ray that is not good enough for the evaluation of the possible injury of the neck. Such lesions that leave the trapezius muscle unopposed occur in the lower cervical region. The C7-Th1 vertebrae may be obscured in muscular or obese patients (Figure2), or in patients with spinal cord lesions that affect the muscles which normally depress shoulders.Only c-spine radiograph one should be satisfied with is the one showing all of the 7 cervical vertebrae (C1-Th1).Most spinal injuries occur at the junctions of the spine: craniocervical, cervicothoracic, thoracolumbar and lumbosacral.Before analyzing cervical radiographs, some additional facts need to be presented.All of the three essential above mentioned projections can be seen in Figure 1.įigure 1: Lateral view with normal slight lordosis (A), Odontoid or open mouth view of the atlas and axis (B), Standard anteroposterior or AP view with open mouth, it can also be taken with closed mouth (C). Addition of the anteroposterior (AP) projection increases sensitivity to approximately 100%. The risk of missing a significant fracture is, according to statistics, less than 1%. Plain radiographs, when they show the lateral projection of the cervical spine and include an open mouth view, are fairly sensitive in identifying c-spine fractures. A more systematic approach to reading cervical radiographs can significantly reduce the chances of missing an important injury. Interpretation of radiographs has its limitations, which more or less depending on the individual’s knowledge of anatomy and clinical experience.īecause anatomical landmarks for measurements can sometimes be difficult to find or identify. Therefore, this chapter will summarize the basics of c-spine x-ray interpretation.

Although current guidelines lead us to use CT scan for a suspected c-spine injury, c-spine x-rays are still valuable in some low resource settings and patient groups who are susceptible to radiation. By Dejvid Ahmetović and Gregor Prosen IntroductionĬ-spine x-ray interpretation is one of the fundamental skills of emergency physicians.

Flexion extension x ray cervical spine